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Ropivacaine combined with dexmedetomidine in ultrasound-guided axillary brachial plexus block in children, a
Jian-Bin Chen1,2, Li-Ming Su3, Xiao-Qi Zhang1
1Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 of Donghai Street, Fengze District, Quanzhou, 362000, China.
Insights
Adding dexmedetomidine to ropivacaine in pediatric brachial plexus blocks improved postoperative pain control and reduced intraoperative heart rate and blood pressure. This adjuvant therapy offers prolonged analgesia without increasing complications or delaying recovery in children undergoing upper limb surgery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Ultrasound-guided brachial plexus blocks are common for pediatric upper limb surgery.
- Ropivacaine provides local anesthesia, but its analgesic duration can be limited.
- Adjuvant medications may enhance block efficacy and duration.
Purpose of the Study:
- To evaluate the efficacy and safety of dexmedetomidine as an adjuvant to ropivacaine in pediatric patients.
- To assess pain control, duration of analgesia, and hemodynamic stability.
- To determine the impact on postoperative recovery and complications.
Main Methods:
- A randomized controlled trial involving 90 children (1-8 years) undergoing upper extremity fracture surgery.
- Participants received either ropivacaine alone (L group) or ropivacaine with 1 μg/kg dexmedetomidine (D group).
- Outcomes included FLACC scores, block/analgesia duration, vital signs, recovery time, and complications.
Main Results:
- The dexmedetomidine group (D) showed significantly lower FLACC scores at 6 hours post-surgery compared to the ropivacaine-only group (L).
- Group D experienced significantly reduced systolic and diastolic blood pressure and heart rate during surgery (T4, T5).
- Postoperative analgesia duration was significantly longer in group D, with no differences in recovery time or complications.
Conclusions:
- Dexmedetomidine (1 μg/kg) as an adjuvant to ropivacaine effectively alleviates postoperative pain up to 6 hours.
- This combination prolongs analgesia maintenance and reduces intraoperative hemodynamic parameters in pediatric patients.
- The adjuvant therapy is safe, with no observed complications or delayed recovery.
Objective:
In this study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia.
Methods:
We enrolled 90 children (aged 1-8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications.
Results:
There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05).
Conclusion:
Dexmedetomidine (1 μg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery.
Clinical Registry Number:
Registration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022.
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